? foreign body in toe

[Jonathan Wride]

Hi,

Interesting case yesterday and outside of my speciality but thought i would ask your opinion nonetheless. Lady comes in 2 months history of 4th toe PIPJ swelling localised to the lateral aspect. Full function in toe and foot just pressure on the focal area of swelling hurts (toes scrunched in shoes etc). Originally came on after she decided to cut an area of skin off the toe and caused an assumed infection which responded partially to antibiotics. Anyway on ultrasound the toe joint and associated tendons etc were completely normal. The area of pain appeared to be a non-vascular cyst, however in the middle of the cyst was a consistently reproducible hyperechoic artefact in both long and short. I was thinking it could be a hair or splinter or is it just artefact? sent her to a podiatric skin lesion specialist for further investigation. i have attached a long a short axis video, very awkward position so not the cleanest of vids!

let me know if you have any thoughts.

Thanks
Jon

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[Stephen Bird]

Hi Jon,

That looks like a foreign body every day of the week,

It looks exactly like a piece of hair that has either become ingrown (unlikely in this location), or more likely a piece of hair that has worked its way in there.

It doesn’t necessarily need to be hair but it is thin and linear in nature. It could be a thin slither of fibre like bamboo or the like.

I have seen an almost identical case recently and we extracted the foreign body under ultrasound guidance and it was a thick horse hair. The patient worked with horses.

Whatever it is it willl feel a whole lot better when someone opens it up and gets it out.

Nice videos.

Steve.

[Jonathan Wride]

Perfect. Thanks for the info as always.

[Stephen Bird]

If you can find out what they fished out please let us know.

Steve.

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